Concept of Trauma
and Guidance for a
Trauma-Informed Approach
Prepared by
SAMHSAs Trauma and Justice Strategic Initiative
July 2014
Acknowledgements
This publication was developed under the leadership of SAMHSAs Trauma and
Justice Strategic Initiative Workgroup: Larke N. Huang (lead), Rebecca Flatow, Tenly
Biggs, Sara Afayee, Kelley Smith, Thomas Clark, and Mary Blake. Support was
provided by SAMHSAs National Center for Trauma-Informed Care, contract number
270-13-0409. Mary Blake and Tenly Biggs serve as the CORs.
Disclaimer
The views, opinions, and content of this publication are those of the authors and do not
necessarily reflect the views, opinions, or policies of SAMHSA or HHS.
Recommended Citation
Substance Abuse and Mental Health Services Administration. SAMHSAs Concept
of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No.
(SMA) xx-xxxx. Rockville, MD: Substance Abuse and Mental Health Services
Administration, 2014.
Originating Office
Office of Policy, Planning and Innovation, Substance Abuse and Mental Health
Services Administration, 1 Choke Cherry Road, Rockville, MD 20857. HHS Publication
No. (SMA) xx-xxxx. Printed 2014.
Contents
Introduction .........................................................................................................................2
Purpose and Approach: Developing a Framework for Trauma
and a Trauma-Informed Approach.......................................................................................3
Background: Trauma Where We Are and How We Got Here.........................................5
SAMHSAs Concept of Trauma...........................................................................................7
AMHSAs Trauma-Informed Approach: Key Assumptions
S
and Principles......................................................................................................................9
Guidance for Implementing a Trauma-Informed Approach ..............................................12
Next Steps: Trauma in the Context of Community ...........................................................17
Conclusion.........................................................................................................................17
Endnotes...........................................................................................................................18
page 1
Introduction
Trauma is a widespread, harmful and costly public
health problem. It occurs as a result of violence,
abuse, neglect, loss, disaster, war and other
emotionally harmful experiences. Trauma has no
boundaries with regard to age, gender, socioeconomic
status, race, ethnicity, geography or sexual orientation.
It is an almost universal experience of people with
mental and substance use disorders. The need
to address trauma is increasingly viewed as an
important component of effective behavioral health
service delivery. Additionally, it has become evident
that addressing trauma requires a multi-pronged,
multi-agency public health approach inclusive of
public education and awareness, prevention and
early identification, and effective trauma-specific
assessment and treatment. In order to maximize the
impact of these efforts, they need to be provided
in an organizational or community context that is
trauma-informed, that is, based on the knowledge
and understanding of trauma and its far-reaching
implications.
page 2
APPROACH
SAMHSA approached this task by integrating three
significant threads of work: trauma focused research
work; practice-generated knowledge about trauma
interventions; and the lessons articulated by survivors
page 3
page 4
page 5
page 6
page 7
page 8
A trauma informed approach is distinct from traumaspecific services or trauma systems. A trauma
informed approach is inclusive of trauma-specific
interventions, whether assessment, treatment or
recovery supports, yet it also incorporates key trauma
principles into the organizational culture.
page 9
page 10
page 11
8. P
rogress Monitoring and
Quality Assurance
9. Financing
10. Evaluation
page 12
page 13
KEY PRINCIPLES
Safety
Trustworthiness
and
Transparency
Peer Support
Collaboration
and Mutuality
Empowerment,
Voice, and
Choice
Cultural,
Historical, and
Gender Issues
10 IMPLEMENTATION DOMAINS
Governance
and
Leadership
How does agency leadership communicate its support and guidance for implementing a
trauma-informed approach?
How do the agencys mission statement and/or written policies and procedures include a
commitment to providing trauma-informed services and supports?
How do leadership and governance structures demonstrate support for the voice and
participation of people using their services who have trauma histories?
Policy
How do the agencys written policies and procedures include a focus on trauma and issues of
safety and confidentiality?
How do the agencys written policies and procedures recognize the pervasiveness of trauma
in the lives of people using services, and express a commitment to reducing re-traumatization
and promoting well-being and recovery?
How do the agencys staffing policies demonstrate a commitment to staff training on providing
services and supports that are culturally relevant and trauma-informed as part of staff
orientation and in-service training?
How do human resources policies attend to the impact of working with people who have
experienced trauma?
What policies and procedures are in place for including trauma survivors/people receiving
services and peer supports in meaningful and significant roles in agency planning,
governance, policy-making, services, and evaluation?
page 14
How does the physical environment promote a sense of safety, calming, and de-escalation
for clients and staff?
In what ways do staff members recognize and address aspects of the physical environment
that may be re-traumatizing, and work with people on developing strategies to deal with this?
How has the agency provided space that both staff and people receiving services can use to
practice self-care?
How has the agency developed mechanisms to address gender-related physical and
emotional safety concerns (e.g., gender-specific spaces and activities).
Engagement
and
Involvement
How do people with lived experience have the opportunity to provide feedback to the
organization on quality improvement processes for better engagement and services?
How do staff members keep people fully informed of rules, procedures, activities, and
schedules, while being mindful that people who are frightened or overwhelmed may have
a difficulty processing information?
How is transparency and trust among staff and clients promoted?
What strategies are used to reduce the sense of power differentials among staff and clients?
How do staff members help people to identify strategies that contribute to feeling comforted
and empowered?
Cross Sector
Collaboration
Is there a system of communication in place with other partner agencies working with the
individual receiving services for making trauma-informed decisions?
Are collaborative partners trauma-informed?
How does the organization identify community providers and referral agencies that have
experience delivering evidence-based trauma services?
What mechanisms are in place to promote cross-sector training on trauma and traumainformed approaches?
Screening,
Assessment,
Treatment
Services
page 15
How does the agency address the emotional stress that can arise when working with
individuals who have had traumatic experiences?
How does the agency support training and workforce development for staff to understand and
increase their trauma knowledge and interventions?
How does the organization ensure that all staff (direct care, supervisors, front desk and
reception, support staff, housekeeping and maintenance) receive basic training on trauma,
its impact, and strategies for trauma-informed approaches across the agency and across
personnel functions?
How does workforce development/staff training address the ways identity, culture, community,
and oppression can affect a persons experience of trauma, access to supports and
resources, and opportunities for safety?
How does on-going workforce development/staff training provide staff supports in developing
the knowledge and skills to work sensitively and effectively with trauma survivors.
What types of training and resources are provided to staff and supervisors on incorporating
trauma-informed practice and supervision in their work?
What workforce development strategies are in place to assist staff in working with peer
supports and recognizing the value of peer support as integral to the organizations
workforce?
Progress
Monitoring
and Quality
Assurance
Is there a system in place that monitors the agencys progress in being trauma-informed?
Does the agency solicit feedback from both staff and individuals receiving services?
What strategies and processes does the agency use to evaluate whether staff members feel
safe and valued at the agency?
How does the agency incorporate attention to culture and trauma in agency operations and
quality improvement processes?
What mechanisms are in place for information collected to be incorporated into the agencys
quality assurance processes and how well do those mechanisms address creating accessible,
culturally relevant, trauma-informed services and supports?
Financing
How does the agencys budget include funding support for ongoing training on trauma and
trauma-informed approaches for leadership and staff development?
What funding exists for cross-sector training on trauma and trauma-informed approaches?
What funding exists for peer specialists?
How does the budget support provision of a safe physical environment?
Evaluation
page 16
Conclusion
As the concept of a trauma-informed approach has
become a central focus in multiple service sectors,
SAMHSA desires to promote a shared understanding
of this concept. The working definitions, key principles,
and guidance presented in this document represent
a beginning step toward clarifying the meaning of this
concept. This document builds upon the extensive
work of researchers, practitioners, policymakers, and
people with lived experience in the field. A standard,
unified working concept will serve to advance the
understanding of trauma and a trauma-informed
approach for public institutions and service sectors.
page 17
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page 20
Paper Submitted by: SAMHSAs Internal Trauma and Trauma-Informed Care Work Group with support from CMHS
Contract: National Center for Trauma-Informed Care and Alternatives to Seclusion and Restraint.
A very special thank you to the Expert Panelists for their commitment and expertise in advancing evidence-based
and best practice models for the implementation of trauma-informed approaches and practices.
SMA #
First printed 2014
page 23